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\par }}\ltrpar \sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\footerr \ltrpar \pard\plain \ltrpar\s16\qr \li0\ri0\widctlpar\tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 
\rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid9520525 
\par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}
{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8
\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\ltrrow\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth1188\clshdrawnil \cellx1080\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4500\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2475\clshdrawnil \cellx8055\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2475\clshdrawnil 
\cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\cs24\super\insrsid1924797 \chftn {\footnote \ltrpar \pard\plain \ltrpar\s22\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \cs24\super\insrsid1924797 \chftn }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid1924797  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1036\langfe1033\langnp1036\insrsid5261486 t}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1036\langfe1033\langnp1036\insrsid1924797 estdoc}{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1036\langfe1033\langnp1036\insrsid5261486        }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1036\langfe1033\langnp1036\insrsid1924797 
test phrase}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid467488\charrsid12519094 {\*\shppict{\pict{\*\picprop\shplid1025{\sp{\sn shapeType}{\sv 75}}{\sp{\sn fFlipH}{\sv 0}}
{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fLockRotation}{\sv 0}}{\sp{\sn fLockAspectRatio}{\sv 1}}{\sp{\sn fLockPosition}{\sv 0}}{\sp{\sn fLockAgainstSelect}{\sv 0}}
{\sp{\sn fLockCropping}{\sv 0}}{\sp{\sn fLockVerticies}{\sv 0}}{\sp{\sn fLockAgainstGrouping}{\sv 0}}{\sp{\sn pictureGray}{\sv 0}}{\sp{\sn pictureBiLevel}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}
{\sp{\sn fLine}{\sv 0}}{\sp{\sn wzName}{\sv Picture 1}}{\sp{\sn dhgt}{\sv 251658240}}{\sp{\sn fHidden}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}\picscalex77\picscaley76\piccropl0\piccropr0\piccropt0\piccropb0
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{\pict\picscalex77\picscaley77\piccropl0\piccropr0\piccropt0\piccropb0\picw1879\pich1931\picwgoal1065\pichgoal1095\wmetafile8\bliptag-262700295\blipupi95{\*\blipuid f05782f9b2ce7ba00475f7d6c46bf0a7}
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0001ffc000003e010101f8000000ff8000001e000000f00000007f0000000e010101fffffffffffffffffe010100fffffffffffffffffe000000040000002701ffff030000000000}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid8401022 REP\'daBLICA  FEDERATIVA DO BRASIL
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid8401022 MINIST\'c9RIO DAS RELA\'c7\'d5ES EXTERIORES
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid5861500 CONSULADO-GERAL EM {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname City}}SAN FRANCISCO}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5861500 {\*\xmlclose}{\*\xmlclose}\cell }\pard \ltrpar
\ql \li0\ri0\sb60\sa100\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 Protocol number\cell Visa number\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth1188\clshdrawnil \cellx1080\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth4500\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2475\clshdrawnil \cellx8055\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2475\clshdrawnil 
\cellx10530\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs12\insrsid8401022 
\par }\pard\plain \ltrpar\s4\qc \li0\ri0\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel3\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \b\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \f1\insrsid8401022 VISA APPLICATION FORM
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\fs8\insrsid8401022 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trrh405\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth8208\clshdrawnil 
\cellx8100\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar
\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 01 -   Full name  
}{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs18\insrsid8401022 (as per passport; do not abbreviate or omit any name)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par                             First                                      Middle                                           Last \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trrh405\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr
\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth8208\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow
}\trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trrh378\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2736\clshdrawnil 
\cellx2628\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2736\clshdrawnil \cellx5364\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth2736\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
{\*\bkmkstart Text42} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001400140000000654657874343200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen20\ffhps20{\*\ffname Text42}}}}}{\fldrslt {\rtlch\fcs1 \af0 
\ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
{\*\bkmkend Text42}\cell }\pard\plain \ltrpar\s15\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst 
{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001400140000000654657874343200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen20\ffhps20{\*\ffname Text42}}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001400140000000654657874343200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen20\ffhps20
{\*\ffname Text42}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\s4\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel3\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\b\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 Attach photo here\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trrh378\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 
\trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl 
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}\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trrh525\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4608\clshdrawnil 
\cellx4500\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3600\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 02 -   Place of birth (city/state/country)\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 03 -  Date of birth

\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022       Day               Month                Year\cell }\pard\plain \ltrpar\s6\qc \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel5\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\b\fs28\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b0\fs8\insrsid8401022 
\par {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \hich\af0\dbch\af0\loch\f0 -\tab}}\pard\plain \ltrpar\ql \fi-360\li360\ri0\widctlpar\intbl\jclisttab\tx252\wrapdefault{\*\pn 
\pnlvlblt\ilvl0\ls5\pnrnot0\pnstart27\pnindent360\pnsp120\pnhang {\pntxtb -}}\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \b\insrsid8401022 size: 40 mm x 35mm}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid8401022 (1 9/6 x 1 3/8 inches)\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trrh525\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4608\clshdrawnil 
\cellx4500\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3600\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4608\clshdrawnil 
\cellx4500\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth1258\clshdrawnil \cellx6838\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1262\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text2} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 
000026001400000005546578743200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen38\ffhps20{\*\ffname Text2}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20
\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text2}
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs10\insrsid8401022 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text3} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 
000002001400000005546578743300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen2\ffhps20{\*\ffname Text3}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text3}\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text4} FORMTEXT }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 000002001400000005546578743400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen2\ffhps20{\*\ffname Text4}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 {\*\bkmkend Text4}\cell }{\field{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text5} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 000004001400000005546578743500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen4\ffhps20{\*\ffname 
Text5}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \i\insrsid8401022 {\*\bkmkend Text5}\cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow3\irowband3\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr
\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4608\clshdrawnil \cellx4500\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1258\clshdrawnil \cellx6838\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1262\clshdrawnil 
\cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trrh588\trleft-108\trbrdrt
\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil \cellx2790\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil 
\cellx5580\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2520\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr
\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 04 -  Country of  citizenship
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\*\bkmkstart Text6}{\field{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 000014001400000005546578743600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen20\ffhps20{\*\ffname Text6}}}}}{\fldrslt 
{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 {\*\bkmkend Text6} \cell 05 -   Sex
\par           male   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check19} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b313900000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check19}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check19}
     female  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check20} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323000000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check20}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check20}  
\cell 06 - Marital status
\par }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text8} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 000010001400000005546578743800000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen16\ffhps20{\*\ffname Text8}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text8} \cell {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 
\fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \hich\af0\dbch\af0\loch\f0 -\tab}}\pard \ltrpar\ql \fi-360\li360\ri0\widctlpar\intbl\jclisttab\tx252\wrapdefault{\*\pn \pnlvlblt\ilvl0\ls4\pnrnot0\pnstart27\pnindent360\pnsp120\pnhang {\pntxtb -}}
\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin360 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid8401022 white or off-white background  \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trrh588\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb
\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil \cellx2790\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrs\brdrw15 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2520\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil 
\cellx2790\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2520\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 07 -   Passport # }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 08 -  Issuing country }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
09 -   Expiration date 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022     Day      Month       Year \cell {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \hich\af0\dbch\af0\loch\f0 -\tab}}\pard\plain \ltrpar
\ql \fi-360\li360\ri0\widctlpar\intbl\jclisttab\tx252\wrapdefault{\*\pn \pnlvlblt\ilvl0\ls6\pnrnot0\pnstart27\pnindent360\pnsp120\pnhang {\pntxtb -}}\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin360 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid8401022 front view, full face\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow5\irowband5\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr
\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil \cellx2790\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil \cellx5580\clvertalt\clbrdrt
\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2520\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts11\trgaph108\trrh333\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil 
\cellx2790\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx6420\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx7260\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530
\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 {\*\bkmkstart Text9} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 000012001400000005546578743900000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen18\ffhps20{\*\ffname Text9}}}}}{\fldrslt {
\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 {\*\bkmkend Text9}\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text10} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001400140000000654657874313000000000000000000000000000
}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen20\ffhps20{\*\ffname Text10}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text10}\cell }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text11} FORMTEXT }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000200140000000654657874313100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen2\ffhps20{\*\ffname Text11}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text11}\cell }{\field{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000200140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen2\ffhps20}}}}{\fldrslt {\rtlch\fcs1 \af0 
\ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }{\field{\*\fldinst {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000400140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen4\ffhps20}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell {\pntext\pard\plain\ltrpar 
\intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \hich\af0\dbch\af0\loch\f0 -\tab}}\pard \ltrpar\ql \fi-360\li360\ri0\widctlpar\intbl\jclisttab\tx252\wrapdefault{\*\pn \pnlvlblt\ilvl0\ls9\pnrnot0
\pnstart27\pnindent360\pnsp120\pnhang {\pntxtb -}}\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin360 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid8401022 must be recent picture\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow6\irowband6\ltrrow\ts11\trgaph108\trrh333\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2898\clshdrawnil 
\cellx2790\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2790\clshdrawnil \cellx5580\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx6420\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx7260\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 
\clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx8100\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2430\clshdrawnil \cellx10530\row \ltrrow
}\trowd \irow7\irowband7\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 10 -   Parent\rquote s full name }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (do not abbreviate or omit any name)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  and country of }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid15364614 birth}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow7\irowband7\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\row \ltrrow}\trowd \irow8\irowband8\ltrrow\ts11\trgaph108\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth828\clshdrawnil \cellx720
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx1800\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth8010\clshdrawnil \cellx9810\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth720\clshdrawnil \cellx10530\pard\plain \ltrpar
\qr \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell 
}\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 Father\rquote s:\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text13} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00004100140000000654657874313300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen65\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text13}\cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow8\irowband8\ltrrow\ts11\trgaph108\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth828\clshdrawnil \cellx720
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx1800\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth8010\clshdrawnil \cellx9810\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth720\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow9\irowband9\ltrrow
\ts11\trgaph108\trleft-108\trbrdrl\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl 
\clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow9\irowband9\ltrrow\ts11\trgaph108\trleft-108\trbrdrl\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\row \ltrrow}\trowd \irow10\irowband10\ltrrow\ts11\trgaph108\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth828\clshdrawnil \cellx720
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx1800\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth8010\clshdrawnil \cellx9810\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth720\clshdrawnil \cellx10530\pard\plain \ltrpar
\qr \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell 
}\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 Mother\rquote s:\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text14} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00004100140000000654657874313400000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen65\ffhps20{\*\ffname Text14}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text14}\cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow10\irowband10\ltrrow\ts11\trgaph108\trleft-108\trkeep\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth828\clshdrawnil \cellx720
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1080\clshdrawnil \cellx1800\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth8010\clshdrawnil \cellx9810\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth720\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow11\irowband11\ltrrow
\ts11\trgaph108\trleft-108\trbrdrl\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone 
\clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow11\irowband11\ltrrow\ts11\trgaph108\trleft-108\trbrdrl\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\row \ltrrow}\trowd \irow12\irowband12\ltrrow\ts11\trgaph108\trrh3465\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148\clshdrawnil 
\cellx5040\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid467488 {\shp{\*\shpinst\shpleft5040\shptop2936\shpright10512\shpbottom2936\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz3\shplid1037
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn dhgt}{\sv 251659264}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8195\dpline\dpptx0\dppty0\dpptx5472\dppty0
\dpx5040\dpy2936\dpxsize5472\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft5040\shptop2216\shpright10512\shpbottom2216\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz2\shplid1036
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn dhgt}{\sv 251658240}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8194\dpline\dpptx0\dppty0\dpptx5472\dppty0
\dpx5040\dpy2216\dpxsize5472\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft5040\shptop1496\shpright10512\shpbottom1496\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz1\shplid1035
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn dhgt}{\sv 251657216}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8193\dpline\dpptx0\dppty0\dpptx5472\dppty0
\dpx5040\dpy1496\dpxsize5472\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}{\shp{\*\shpinst\shpleft5040\shptop776\shpright10512\shpbottom776\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz0\shplid1032
{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn dhgt}{\sv 251656192}}{\sp{\sn fLayoutInCell}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 0}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8192\dpline\dpptx0\dppty0\dpptx5472\dppty0
\dpx5040\dpy776\dpxsize5472\dpysize0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 11 \endash  Highest level of education (check only one box)
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\fs16\insrsid8401022 
\par }\pard\plain \ltrpar\ql \li0\ri0\sa60\widctlpar\intbl\tx450\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check21} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check21}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check21}
  no diploma
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check22} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check22}
  high school diploma or the equivalent }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (e.g., GED)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check23} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323300000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check23}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check23}
  some college credit, but less than one year
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check24} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323400000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check24}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check24}
  more than one year of college, but no degree
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check25} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check25}
  associate\rquote s degree }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (e.g., AA, AS)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check26} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check26}
  bachelor\rquote s degree }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (e.g., BA, AB, BS)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\sa60\widctlpar\intbl\tx450\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check27} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323700000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check27}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check27}
  master\rquote s degree
\par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\tx450\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
{\*\bkmkstart Check28} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323800000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check28}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check28}  professional degree (e.g., }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  MD, DDS DVM, LLB,

\par }\pard \ltrpar\s15\ql \li0\ri0\sa60\widctlpar\intbl\tx450\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022                      JD}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 )
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Check29} FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b323900000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check29}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Check29}
  doctorate degree\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 12 -  Major/primary field of study
\par          }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text43} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00002800140000000654657874343300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20{\*\ffname Text43}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text43}
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs6\insrsid8401022 
\par 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\sb140\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 13 -  List any special skill and/or certificates
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022   
       }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00002800140000000654657874343300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20
{\*\ffname Text43}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs12\insrsid8401022 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 14 -  Job position }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (as per business card)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  or title
\par }\pard \ltrpar\ql \li0\ri0\sa100\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022          }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00002800140000000654657874343300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20{\*\ffname Text43}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\sb20\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 15 -  Employer }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 (for students, name school/university)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\sa100\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022          }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00002800140000000654657874343300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20{\*\ffname Text43}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  16 \endash  E-mail: 
\par          }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00002800140000000654657874343300000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20{\*\ffname Text43}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow12\irowband12\ltrrow\ts11\trgaph108\trrh3465\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrdb\brdrw15 
\clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5148\clshdrawnil \cellx5040\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5490\clshdrawnil \cellx10530\row \ltrrow
}\trowd \irow13\irowband13\ltrrow\ts11\trgaph108\trrh602\trleft-108\trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil 
\cellx6300\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4230\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 17 -  Business address

\par        }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00004600140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen70\ffhps20}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs6\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 18 -   Business telephone # (with area code)
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022           }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001900140000000000000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen25\ffhps20}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow13\irowband13\ltrrow\ts11\trgaph108\trrh602\trleft-108\trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrs\brdrw15 
\trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone 
\clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4230\clshdrawnil \cellx10530\row \ltrrow
}\trowd \irow14\irowband14\lastrow \ltrrow\ts11\trgaph108\trrh602\trleft-108\trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4230\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 19 -  Home address

\par        }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00004600140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen70\ffhps20}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs6\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 20 -   Home telephone # (with area code)
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022           }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00001900140000000000000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen25\ffhps20}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow14\irowband14\lastrow \ltrrow\ts11\trgaph108\trrh602\trleft-108\trbrdrl\brdrdb\brdrw15 \trbrdrb
\brdrs\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 
\clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4230\clshdrawnil 
\cellx10530\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw30 \trbrdrl\brdrs\brdrw30 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrs\brdrw30 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw45 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\pard\plain \ltrpar\s6\qc \li0\ri0\sb40\sa40\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel5\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \b\fs28\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 FOR OFFICIAL USE ONLY\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw30 \trbrdrl\brdrs\brdrw30 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrs\brdrw30 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw45 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrtbl \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil 
\cellx10530\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx3444\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx6996\clvertalt\clbrdrt\brdrs\brdrw15 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth3534\clshdrawnil \cellx10530\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 A -   Consulta \'e0 SERE
\par }\pard \ltrpar\ql \li0\ri0\sb160\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022   OF   }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol"
 \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022     TEL    }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
       No. _______}{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 B -   Autoriza\'e7\'e3o da SERE

\par }\pard \ltrpar\ql \li0\ri0\sb160\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 DESP  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol"
 \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022    DESPTEL  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
   No.  ______ \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 C -  Tipo do Visto
\par }\pard \ltrpar\ql \li0\ri0\sb160\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022         ___________________\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx3444\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx6996\clvertalt\clbrdrt\brdrs\brdrw15 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth3534\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb
\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw45 \clbrdrb
\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil \cellx2556\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil \cellx5220
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil \cellx7884\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw45 
\cltxlrtb\clftsWidth3\clwWidth2646\clshdrawnil \cellx10530\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 D -  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\fs22\insrsid8401022     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 Concess\'e3o
\par {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \loch\af3\dbch\af0\hich\f3 \'94\tab}}\pard\plain \ltrpar\ql \fi-360\li720\ri0\widctlpar\intbl\jclisttab\tx720\wrapdefault{\*\pn 
\pnlvlblt\ilvl0\ls2\pnrnot0\pnf3\pnstart21\pnindent360\pnsp120\pnhang {\pntxtb \'94}}\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid8401022 Denega\'e7\'e3o 
\par {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs20\lang1033\langfe1033\langnp1033\insrsid8401022 \loch\af3\dbch\af0\hich\f3 \'94\tab}}\pard \ltrpar\ql \fi-360\li720\ri0\widctlpar\intbl\jclisttab\tx720\wrapdefault{\*\pn 
\pnlvlblt\ilvl0\ls2\pnrnot0\pnf3\pnstart21\pnindent360\pnsp120\pnhang {\pntxtb \'94}}\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin720 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 Impedimento \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 E -   }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}
{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022    Uma entrada
\par }\pard \ltrpar\ql \li0\ri0\sb60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs18\insrsid8401022  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
   }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\field{\*\fldinst SYMBOL 148 \\f "Symbol" \\s 10}{\fldrslt\f3\fs20}}}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022    M\'faltiplas entradas \cell }\pard\plain \ltrpar
\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 F -  Validade

\par }\pard \ltrpar\s15\ql \li0\ri0\sb140\sa40\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022       _____________anos/dias\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 G -  Data
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\sb140\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022      ______/______/______\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil 
\cellx2556\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil \cellx5220\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2664\clshdrawnil \cellx7884\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth2646\clshdrawnil \cellx10530\row \ltrrow
}\trowd \irow3\irowband3\lastrow \ltrrow\ts11\trgaph108\trrh903\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrs\brdrw45 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5328\clshdrawnil 
\cellx5220\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw45 \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth5310\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 H -  Observa\'e7\'f5es

\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2648837 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid9581753 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 I -  Assinaturas
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022       Funcion\'e1rio                                          Chefia                                                             \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow3\irowband3\lastrow \ltrrow\ts11\trgaph108\trrh903\trleft-108\trbrdrt\brdrs\brdrw45 \trbrdrl\brdrs\brdrw45 \trbrdrb\brdrs\brdrw45 \trbrdrr\brdrs\brdrw45 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw45 \clbrdrb\brdrs\brdrw45 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5328\clshdrawnil 
\cellx5220\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw45 \clbrdrr\brdrs\brdrw45 \cltxlrtb\clftsWidth3\clwWidth5310\clshdrawnil \cellx10530\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs6\insrsid8401022 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trrh387\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar
\qj \li0\ri0\sb40\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
21 -  Purpose of trip (check item that is the most applicable to the circumstances of your trip)
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trrh387\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrdb\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl
\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth558\clshdrawnil \cellx450\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10080\clshdrawnil \cellx10530\pard\plain \ltrpar
\qr \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 
\i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid467488 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 
\par 
\par 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs16\insrsid8401022 \cell }\pard\plain \ltrpar\s17\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\i\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\insrsid8401022 
Provide services in Brazil of a temporary nature, including activities such as office and technical support, installation and repair of equipment, including computer and telecommunications systems, construction activities, and direct supervision of  perso
nnel in Brazil}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\insrsid8401022 
U.S.-based personnel involved in business development activities, including negotiating contracts, marketing, opportunity assessments, specifying orders for contracts, customer relations related activities, performance assessments, project r
eviews, and establishing a  framework for doing business in Brazil
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
Direct participation in oil and gas exploration and/or production activities
\par Work under an employment contract with a company/organization in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose}
  -  i.e., hired under a Brazilian labor contract as a local employee  (this applies to the foreign employees of multinationals working in their Brazilian subsidiaries)
\par Transfer of residence to {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose} under permanent residency status
\par Attend conference, seminar or workshop (note under  \'93Comments\'94 below whether attendee, paid/unpaid speaker, trainer, and provide name of event sponsor)
\par Provide religious or missionary services and/or assistance
\par Provide community and/or medical services 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 Attend school or pursue studies
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
Conduct research or pursue scientific-technologic activities under an international cooperation program
\par Pursue professorial studies/research/teaching and/or pursue scientific/technologic activities at an university,  research or similar organization (attach letter specifying conditions: employment contract? research scholarship? )
\par Participation in athletic or performing arts events (note under \'93Comments\'94  below  whether paid/unpaid participation)
\par Journalism activities and/or  film making
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \i\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \i0\insrsid8401022 As a government official
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
Tourism, visit friend(s) and/or relatives (under \'93Comments\'94  below  provide further insight on intended trip and, as applicable, list relationship to parties being visited)
\par }\pard\plain \ltrpar\s2\ql \li0\ri0\keepn\widctlpar\intbl\tqr\tx9504\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \i\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\insrsid8401022 Other: }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022   {\*\bkmkstart Text40}}{\field\fldlock{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\i0\ul\insrsid13401669 {\*\datafield 00005000140000000654657874343000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen80\ffhps20{\*\ffname Text40}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\i0\ul\lang1024\langfe1024\noproof\insrsid8401022      }}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022 {\*\bkmkend Text40}\tab 
\par }\pard \ltrpar\s2\ql \li0\ri0\sb60\keepn\widctlpar\intbl\tqr\tx9522\wrapdefault\aspalpha\aspnum\faauto\outlinelevel1\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\insrsid8401022     Comments: }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022 
  {\*\bkmkstart Text41}}{\field\fldlock{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid13401669 {\*\datafield 00004b00140000000654657874343100000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen75\ffhps20{\*\ffname Text41}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\lang1024\langfe1024\noproof\insrsid8401022      }}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i0\ul\insrsid8401022 {\*\bkmkend Text41}\tab 
\par }\pard\plain \ltrpar\ql \li0\ri0\sb60\widctlpar\intbl\tqr\tx9518\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022                       }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid8401022    }{\field\fldlock{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid13401669 {\*\datafield 
00004b00140000000654657874343100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen75\ffhps20{\*\ffname Text41}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\lang1024\langfe1024\noproof\insrsid8401022      }}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid8401022 \tab 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022                       }{\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid8401022    }{\field\fldlock{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\i\ul\insrsid13401669 {\*\datafield 00004b00140000000654657874343100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen75\ffhps20{\*\ffname Text41}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\i\ul\lang1024\langfe1024\noproof\insrsid8401022      }}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \ul\insrsid8401022 \tab 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs4\insrsid8401022 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow1\irowband1\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth558\clshdrawnil \cellx450\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10080\clshdrawnil 
\cellx10530\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trrh615\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5328\clshdrawnil 
\cellx5220\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5310\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
22 -   Expected port of entry and date of arrival in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose}      }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022  }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \i\fs16\insrsid8401022 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text28} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 
{\*\datafield 00002300140000000654657874323800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen35\ffhps20{\*\ffname Text28}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194
\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 {\*\bkmkend Text28}
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 23 -   Expected duration of  immediate trip       }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs16\insrsid8401022 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\*\bkmkstart Text30}{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 
{\*\datafield 00002000140000000654657874333000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen32\ffhps20{\*\ffname Text30}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194
\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text30}\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow2\irowband2\ltrrow\ts11\trgaph108\trrh615\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5328\clshdrawnil 
\cellx5220\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5310\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trgaph108\trleft-108\trbrdrt
\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 
\clbrdrb\brdrs\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 24 -   Name and address of person, institution or company through whom you can be contacted in {\*\xmlopen\xmlns2{\factoidname place}}
{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose}
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\fs8\insrsid8401022 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\*\bkmkstart Text22}{\field{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00005000140000000654657874323200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen80\ffhps20{\*\ffname Text22}}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text22}
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow3\irowband3\ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trrh828\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6768\clshdrawnil 
\cellx6660\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3870\clshdrawnil \cellx10530\pard\plain \ltrpar
\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 25 -  Address  in 
{\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose} where you will be staying  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs18\insrsid8401022 (e.g., hotel, vessel, friend, other)}{\rtlch\fcs1 
\af0 \ltrch\fcs0 \i\insrsid8401022 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\i\fs8\insrsid8401022 
\par {\*\bkmkstart Text24}}{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00003200140000000654657874323400000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen50\ffhps20{\*\ffname Text24}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022 {\*\bkmkend Text24}
\par {\*\bkmkstart Text25}}{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00003200140000000654657874323500000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen50\ffhps20{\*\ffname Text25}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text25}  }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
26 -   Telephone # in {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose} }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs18\insrsid8401022 (with city code)}{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022     }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\fs8\insrsid8401022 
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text27} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000c00140000000654657874323700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen12\ffhps20{\*\ffname Text27}}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text27} \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \irow4\irowband4\ltrrow\ts11\trgaph108\trrh828\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr
\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth6768\clshdrawnil \cellx6660\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrtbl \clbrdrb\brdrnone \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3870\clshdrawnil \cellx10530\row \ltrrow}\trowd \irow5\irowband5\lastrow \ltrrow
\ts11\trgaph108\trrh732\trleft-108\trbrdrt\brdrs\brdrw15 \trbrdrl\brdrs\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrs\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4248\clshdrawnil 
\cellx4140\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6390\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\sb40\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
27 -   Have you ever been to {\*\xmlopen\xmlns2{\factoidname place}}{\*\xmlopen\xmlns2{\factoidname country-region}}Brazil{\*\xmlclose}{\*\xmlclose}?  
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022            }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMCHECKBOX }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b313600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check16}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022     Yes                  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMCHECKBOX }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid467488 {\*\datafield 650000001400000007436865636b313700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check17}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022     No\cell 28 -    If yes for item 27, provide date, place and duration of last visit
\par }\pard \ltrpar\ql \li0\ri0\sa20\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022          }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\insrsid8401022  }{\field{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00003200140000000000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen50\ffhps20}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\trowd \irow5\irowband5\lastrow \ltrrow\ts11\trgaph108\trrh732\trleft-108\trbrdrt\brdrs\brdrw15 \trbrdrl\brdrs\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrs\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4248\clshdrawnil 
\cellx4140\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6390\clshdrawnil \cellx10530\row }\pard\plain \ltrpar
\s15\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 
\par }\pard\plain \ltrpar\s7\ql \li0\ri432\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel6\adjustright\rin432\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \b\caps\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af0 \ltrch\fcs0 \f1\fs22\cf2\insrsid8401022 IMPORTANT:}{\rtlch\fcs1 \af0 \ltrch\fcs0 \f1\fs20\cf2\insrsid8401022  FORMS THAT ARE INCOMPLETE  AND INCORRECTLY  FILLED OUT  WILL  BE  RETURNED. 
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\f1\cf2\insrsid8401022                          }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\f1\cf2\insrsid8401022 CAREFULLY READ AND FOLLOW INSTRUCTIONS AT THE BOTTOM OF THIS PAGE.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\fs8\insrsid8401022 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 
\par \ltrrow}\trowd \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
29 -   I declare that  the above information is true and accurate.
\par }\pard\plain \ltrpar\s15\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022    Name (type or print)                                                                  Date                                    Signature \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \ltrrow
\ts11\trgaph108\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw15 \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\row \ltrrow}\trowd \ltrrow\ts11\trgaph108\trrh80\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb
\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs6\insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \ltrrow\ts11\trgaph108\trrh80\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr
\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrtbl \clbrdrr\brdrdb\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\row \ltrrow}\trowd \lastrow \ltrrow\ts11\trgaph108\trrh468\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 \trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4158\clshdrawnil 
\cellx4050\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth900\clshdrawnil \cellx4950\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr
\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth990\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth900\clshdrawnil \cellx6840\clvertalt\clbrdrt\brdrtbl 
\clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3690\clshdrawnil \cellx10530\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par }\pard \ltrpar\ql \li0\ri0\sa20\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 {\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkstart Text32} FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 
{\*\datafield 00002800140000000654657874333200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen40\ffhps20{\*\ffname Text32}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194
\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text32} }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs18\insrsid8401022 Day{\*\bkmkstart Text33}
\par }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000400140000000654657874333300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen4\ffhps20
{\*\ffname Text33}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text33} }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs18\insrsid8401022 Month}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 
\par {\*\bkmkstart Text34}}{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000400140000000654657874333400000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffmaxlen4\ffhps20{\*\ffname Text34}}}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 {\*\bkmkend Text34} }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }\pard\plain \ltrpar
\s15\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs18\insrsid8401022 Year

\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\*\bkmkstart Text35}{\field{\*\fldinst {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022  FORMTEXT }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13401669 {\*\datafield 00000400140000000654657874333500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffmaxlen4\ffhps20{\*\ffname Text35}}}}
}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid8401022 \u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery0\footery864\endnhere\sectdefaultcl\sectrsid6358344\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid8401022 {\*\bkmkend Text35} }{\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\insrsid8401022 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 \trowd \lastrow \ltrrow\ts11\trgaph108\trrh468\trleft-108\trbrdrt\brdrdb\brdrw15 \trbrdrl\brdrdb\brdrw15 
\trbrdrb\brdrdb\brdrw15 \trbrdrr\brdrdb\brdrw15 \trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrdb\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4158\clshdrawnil \cellx4050\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth900\clshdrawnil \cellx4950\clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 \cltxlrtb\clftsWidth3\clwWidth990\clshdrawnil \cellx5940\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth900\clshdrawnil \cellx6840\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrdb\brdrw15 \clbrdrr\brdrdb\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3690\clshdrawnil \cellx10530\row }\pard\plain \ltrpar
\s15\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs8\insrsid8401022 
\par 
\par \ltrrow}\trowd \lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw15 \trbrdrl\brdrs\brdrw15 \trbrdrb\brdrs\brdrw15 \trbrdrr\brdrs\brdrw15 \trbrdrh\brdrs\brdrw15 \trbrdrv\brdrs\brdrw15 
\trftsWidth1\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw15 \clbrdrl\brdrs\brdrw15 \clbrdrb\brdrs\brdrw15 \clbrdrr\brdrs\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth10638\clshdrawnil \cellx10530\pard\plain \ltrpar\s5\qc \li0\ri0\sb40\keepn\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\outlinelevel4\adjustright\rin0\lin0\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\b\fs18\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8401022 INSTRUCTIONS
\par {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs18\lang1033\langfe1033\langnp1033\insrsid8401022 \loch\af3\dbch\af0\hich\f3 \'a8\tab}}\pard\plain \ltrpar\ql \fi-360\li360\ri0\widctlpar\intbl\tx360\wrapdefault{\*\pn 
\pnlvlbody\ilvl0\ls1\pnrnot0\pnf3\pnstart1\pnindent360\pnhang {\pntxtb \'a8}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\yts11 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \fs18\insrsid8401022 Type or write in block letters, on blue or black ink only.  Form can be filled out on line.
\par {\pntext\pard\plain\ltrpar \intbl\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f3\fs18\lang1033\langfe1033\langnp1033\insrsid8401022 \loch\af3\dbch\af0\hich\f3 \'a8\tab}}\pard \ltrpar\ql \fi-360\li360\ri0\widctlpar\intbl\tx360\wrapdefault{\*\pn 
\pnlvlbody\ilvl0\ls1\pnrnot0\pnf3\pnstart1\pnindent360\pnhang {\pntxtb \'a8}}\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin360\yts11 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs18\insrsid8401022 Complete first and second pages, except for box marked \'93
For Offical Use Only\'94.
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Answer all questions thoroughly and accurately.  If a question does not apply, please type N/A. 
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